Skip to main content
SpringerLink
Log in

Impact of fatigue on the efficacy of rehabilitation in multiple sclerosis

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Fatigue is considered to be one of the most common and disabling symptoms among individuals with multiple sclerosis (MS). The aim of this study is to investigate if an intensive, short-term inpatient rehabilitation program is able to improve fatigue in MS, and if fatigue is able to negatively influence the clinical and functional outcome of rehabilitation in MS. One-hundred eighty six consecutively recruited MS patients underwent an intensive, short-term inpatient rehabilitation program. Sixty-four of them were selected for this study according to our inclusion criteria and compared to a control group of 22 MS patients who did not follow a rehabilitation program. We measured fatigue symptoms with the Fatigue Severity Scale (FSS) before and after rehabilitation, and classified patients into fatigued (FMS) in the case of an FSS score ≥36 and into non-fatigued MS (NFMS) in the case of an FSS <36. Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) were used as clinical outcome measures of the efficacy of the rehabilitation program. In our sample, an intensive, short-term rehabilitation treatment is able to determine a significant reduction of fatigue symptoms compared to untreated MS patients (p < 0.0001); however, the presence of fatigue at the beginning of the rehab program seems not to have any impact on the clinical and functional outcome of rehabilitation. An intensive inpatient rehabilitation trial decreases symptom of fatigue in MS patients; furthermore fatigue seems not to modify the amelioration of disability and impairment determined by a rehabilitation program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Multiple Sclerosis Council for Clinical Practice Guidelines (1998) Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis. Paralyzed Veterans of America, Washington, DC

    Google Scholar 

  2. Iriarte J, Subira ML, Castro P (2000) Modalities of fatigue in multiple sclerosis: correlation with clinical and biological factors. Mult Scler 6:124–130

    Article  PubMed  CAS  Google Scholar 

  3. Fisk JD, Pontefract A, Ritvo PG, Archibald CJ, Murray TJ (1994) The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 21:9–14

    PubMed  CAS  Google Scholar 

  4. Freal JE, Kraft GH, Coryell JK (1984) Symptomatic fatigue in multiple sclerosis. Arch Phys Med Rehabil 65:135–138

    PubMed  CAS  Google Scholar 

  5. Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC (1988) Fatigue in multiple sclerosis. Arch Neurol 45:435–437

    PubMed  CAS  Google Scholar 

  6. Kos D, Kerckhofs E, Nagels G, D’hooghe MB, Ilsbroukx S (2008) Origin of fatigue in multiple sclerosis: review of the literature. Neurorehabil Neural Repair 22:91–100

    PubMed  CAS  Google Scholar 

  7. Leocani L, Colombo B, Comi G (2008) Physiopathology of fatigue in multiple sclerosis. Neurol Sci 29:241–243

    Article  Google Scholar 

  8. Ponichtera-Mulcare J (1992) Exercise and multiple sclerosis. Med Sci Sports Exerc 25:451–465

    Google Scholar 

  9. Sutherland G, Andersen MB (2001) Exercise and multiple sclerosis: physiological, psychological, and quality of life issues. J Sports Med Phys Fit 41:421–432

    CAS  Google Scholar 

  10. Bergamaschi R, Romani A, Versino M, Poli R, Cosi V (1997) Clinical aspects of fatigue in multiple sclerosis. Funct Neurol 12:247–251

    PubMed  CAS  Google Scholar 

  11. Pittion-Vouyovitch S, Debouverie M, Guillemin F, Vandenberghe N, Anxionnat R, Vespignani H (2006) Fatigue in multiple sclerosis is related to disability, depression and quality of life. J Neurol Sci 243:39–45

    Article  PubMed  CAS  Google Scholar 

  12. Vercoulen JH, Hommes OR, Swanink CM, Jongen PJ, Fennis JF, Galama JM et al (1996) The measurement of fatigue in patients with multiple sclerosis. A multidimensional comparison with patients with chronic fatigue syndrome and healthy subjects. Arch Neurol 53:642–649

    PubMed  CAS  Google Scholar 

  13. Vercoulen JH, Swanink CM, Galama JM, Fennis JF, Jongen PJ, Hommes OR et al (1998) The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model. J Psychosom Res 45:507–517

    Article  PubMed  CAS  Google Scholar 

  14. Bakshi R, Shaikh ZA, Miletich RS, Czarnecki D, Dmochowski J, Henschel K et al (2000) Fatigue in multiple sclerosis and its relationship to depression and neurologic disability. Mult Scler 6:181–185

    PubMed  CAS  Google Scholar 

  15. Krupp LB, Coyle PK, Doscher C, Miller A, Cross AH, Jandorf L et al (1995) Fatigue therapy in multiple sclerosis: results of a doubleblind, randomised, parallel trial of amantadine, emoline and placebo. Neurology 45:1956–1961

    PubMed  CAS  Google Scholar 

  16. Mohr DC, Hart SL, Goldberg A (2003) Effects of treatment for depression on fatigue in multiple sclerosis. Psychosom Med 65:542–547

    Article  PubMed  Google Scholar 

  17. Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M et al (2004) Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology 62:2058–2064

    PubMed  CAS  Google Scholar 

  18. Mathiowetz V, Finlayson ML, Matuska KM, Yun Chen H, Luo P (2005) Randomized controlled trial of an energy conservation course for persons with multiple sclerosis. Mult Scler 11:592–601

    Article  PubMed  Google Scholar 

  19. Patti F, Ciancio MR, Reggio E, Lopes R, Palermo F, Cacopardo M et al (2002) The impact of outpatient rehabilitation on quality of life in multiple sclerosis. J Neurol 249:1027–1033

    Article  PubMed  Google Scholar 

  20. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  PubMed  CAS  Google Scholar 

  21. Tombaugh TN (2006) A comprehensive review of the Paced Auditory Serial Addition Test (PASAT). Arch Clin Neuropsychol 21:53–76

    Article  PubMed  Google Scholar 

  22. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452

    PubMed  CAS  Google Scholar 

  23. Lublin FD, Reingold SC (1996) Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 46:907–911

    PubMed  CAS  Google Scholar 

  24. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123

    PubMed  CAS  Google Scholar 

  25. Sharrack B, Hughes RA, Soudain S, Dunn G (1999) The psychometric properties of clinical rating scales used in multiple sclerosis. Brain 122:141–159

    Article  PubMed  Google Scholar 

  26. Cutter G, Baier M, Rudick R, Cookfair D et al (1999) Development of a multiple sclerosis functional composite as a clinical trial outcome measure. Brain 122:871–882

    Article  PubMed  Google Scholar 

  27. Colombo B, Martinelli Boneschi F, Rossi P, Rovaris M, Maderna L, Filippi F et al (2000) MRI and motor evoked potential findings in nondisabled multiple sclerosis patients with and without symptoms of fatigue. J Neurol 247:506–509

    Article  PubMed  CAS  Google Scholar 

  28. Leocani L, Colombo B, Magnani G, Martinelli-Boneschi F, Cursi M, Rossi P et al (2001) Fatigue in multiple sclerosis is associated with abnormal cortical activation to voluntary movement—EEG evidence. Neuroimage 13:1186–1192

    Article  PubMed  CAS  Google Scholar 

  29. Codella M, Rocca MA, Colombo B, Rossi P, Comi G, Filippi M (2002) A preliminary study of magnetization transfer and diffusion tensor MRI of multiple sclerosis patients with fatigue. J Neurol 249:535–537

    Article  PubMed  Google Scholar 

  30. Lapierre Y, Hum S (2007) Treating fatigue. Int MS J 14:64–71

    PubMed  CAS  Google Scholar 

  31. Lee D, Newell R, Ziegler L, Topping A (2008) Treatment of fatigue in multiple sclerosis: a systematic review of the literature. Int J Nurs Pract 14:81–93

    Article  PubMed  CAS  Google Scholar 

  32. Romberg A, Ruutiainen J, Puukka P, Poikkeus L (2008) Fatigue in multiple sclerosis patients during inpatient rehabilitation. Disabil Rehabil 30:1480–1485

    Article  PubMed  CAS  Google Scholar 

  33. Lange R, Volkmer M, Heesen C, Liepert J (2009) Modafinil effects in multiple sclerosis patients with fatigue. J Neurol 256(9):645–650

    Article  PubMed  CAS  Google Scholar 

  34. Smith C, Hale H, Olson K, Schneiders A (2009) How does exercise influence fatigue in people with multiple sclerosis? Disabil Rehabil 31(9):685–692

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurorehabilitation Unit, Department of Neurology, Institute of Experimental Neurology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy

    Elda Judica, Filippo Martinelli Boneschi, Daniela Ungaro, Mauro Comola, Roberto Gatti, Giancarlo Comi & Paolo Rossi

Authors
  1. Elda Judica
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Filippo Martinelli Boneschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Ungaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mauro Comola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Gatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giancarlo Comi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Rossi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Judica, E., Martinelli Boneschi, F., Ungaro, D. et al. Impact of fatigue on the efficacy of rehabilitation in multiple sclerosis. J Neurol 258, 835–839 (2011). https://doi.org/10.1007/s00415-010-5851-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-010-5851-6

Keywords

Search

Navigation